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Child & Adolescent Development: Overview

Review of "Bipolar Disorders"

By Mitzi Waltz
O'Reilly & Associates, 2000
Review by Christopher A. Lamps, M.D. on Jan 3rd 2001
Bipolar DisordersOne of the cornerstones of effective pediatric psychiatric treatment is education. In practice, education is sometimes a casualty of the time limits facing mental health practitioners. Patients and their families may struggle to find accurate and helpful information on mental illness and its treatment. In the case of childhood bipolar disorders, this is particularly true since patients may have a broad range of impairments in addition to sometimes facing isolation and stigmatization in their communities. This book is a leap forward in enabling the families of children with bipolar disorder to educate themselves. In her preface, Mitzi Waltz states her goal: "This book is intended to bring together all the basic information needed by parents of a child or teenager diagnosed with a bipolar disorder. Professionals who work with bipolar disorder should also find it useful." This is a Herculean task, but Waltz accomplishes it. Interestingly, she is not a psychiatrist, a psychologist, a social worker, or any other professional mental health provider. She instead is a journalist as well as the mother of a child with a bipolar disorder. She shares the story of her daughter's (and her own) struggles as part of the preface.

The style and structure of Bipolar Disorders make its 442 pages easy to read and reference. The spacing and font size minimize eye fatigue. Frequent brief clinical vignettes based on the author's communications with others illustrate and highlight key points. After the preface, the book has nine chapters. The first chapter, "What are Bipolar Disorders?", describes the diagnostic criteria for bipolar disorders and discusses their causes, comorbid illnesses, and potential negative effects of these disorders. The second chapter, "Getting a Diagnosis", provides information on getting and understanding a diagnostic evaluation. Though in general these chapters provide fundamental and useful information, some of their content is questionable. For example, in discussing psychotic symptoms in bipolar disorders, Waltz writes: "When a person has psychotic symptoms, some kind of chemical or electrical process in the brain has gone terribly wrong. This cannot be fixed by psychotherapy, although therapy may be a useful part of a total treatment plan… There are many medications available that can alleviate psychotic symptoms". It is true that psychotic symptoms associated with mood or psychotic disorders require medication treatment. However, hallucinations sometimes occur in the context of a broad range of conditions including substance abuse, seizures, migraines, grief and stress reactions. In some of these cases psychotherapy may be an effective treatment. Despite this and a few other questionable conclusions, these two chapters provide a good introduction to bipolar disorders.

Chapter 3 provides great insights into how to live with a child with bipolar disorder. Its recommendations range from improving the structure of the home, to handling substance abuse, to the utility of support groups. Chapter 4 reviews medications used for bipolar disorders, including medications not currently available in the United States. Chapter 5 discusses therapeutic interventions for bipolar disorders. This chapter provides a very good summary of the types of therapy available as well as the various qualifications of potential therapists. Chapter 6 introduces some alternative treatments ranging from acupuncture to dietary changes to herbal supplements. Though there is little scientific evidence to support many of these treatments, this chapter provides a balanced discussion of these treatment options.

The final three chapters focus on handling insurance, schools, and the transition of bipolar patients into adulthood. Each of these provides valuable and practical information for parents. I found the chapter on schools particularly valuable. The laws covering special education are complicated even for those used to working with the system, but can be a daunting maze for the uninitiated. She includes sections on the systems of other English speaking countries (United Kingdom, Ireland, Australia, New Zealand), broadening the utility of this book. Waltz does a good job of providing both an overview of special education and a guide to advocating for those in need of it. Finally, the book has an appendix listing a broad range of resources for parents or patients seeking more detailed information.

Mitzi Waltz has written a practical and extremely valuable resource for parents of children with bipolar disorder. Besides recommending this book as essential reading to the families of my bipolar patients, I will also recommend this text to professionals, including psychiatry residents, seeking to broaden their understanding of the range of treatments and interventions for bipolar disorders.

Dr. Lamps is the Medical Director of the outpatient pediatric psychiatry clinic at Arkansas Children's Hospital in Little Rock. The clinic is also part of the University of Arkansas for Medical Sciences (UAMS), where he holds his faculty appointment. He attended medical school and trained in adult psychiatry at Vanderbilt University, and completed child psychiatry training at UAMS in June of 2000. His primary clinical activities include patient care and supervising psychiatry residents; his primary clinical interests are in treating anxiety disorders.

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